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•••The  human  spine. 


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2-  /  i 


The  Gypsum  Jacket 


VERSUS 


Compound  Supports. 


THE    HUMAN    SPINE. 


AN  ANALYSIS 


THE    COMPARATIVE    MERITS    OF    THE 


GYPSUM   JACKET 


COMPOUND  ADJUSTABLE  SUPPORTS 


IN    THE    PHYSICAL   TREATMENT   OF 


SPINAL   IRRITATION,  CARIES,  CURVATURE. 

TOGETHER   WITH    THE 

CONSERVATION  OF  THE  VISCERAL  AND  MUSCULAR  FUNCTIONS 

E.     P.     BANNING,    M.  D., 

BOSTON,    MASS, 


BOSTON: 

Alfred   Mudgb   &   Son,   34   School   Street. 
i88r. 


Copyright,  by  E.  P.  Banning,  Jr.,  1881. 


/8rS/ 


Fig.  I. 


Fig.  2. 


Fig.  I.    The  Gypsum  or  Plaster  Jacket. 

Fig.  2.  The  G\'psum  or  Plaster  Jacket  applied :  Endeavoring  to  correct  curvature 
by  circiilar  action ;  compressing  the  primae  vias,  interfering  with  respiration,  and  for- 
dng  the  abdominal  viscera  downward. 


NOTE. 

In  1866  a  series  of  articles  on  the  truncal  muscles,  from 
the  pen  of  the  writer,  appeared  in  the  Philadelphia  Medi- 
cal and  Surgical  Reporter^  and  there  was  a  very  general 
request  that  they  should  be  published  in  the  form  of  a  mono- 
gra  Dh,  which  was  done  by  the  publishers  of  '*  Braithwate^'' 
the  work  being  known  as  '''' Banning s  Mechanical  Pathology 
and  Therapeutics.^^  It  ran  through  several  editions,  and 
would  probably  be  in  press  to-day  had  not  the  plates  been 
destroyed  by  fire.  At  the  suggestion  of  the  publishers  it 
is  being  rewritten,  and  the  result  of  late  researches  and 
experience  added. 

This  pamphlet  is  from  the  forthcoming  book,  which  will 
bear  the  title  of  ''Vital Mechanics.'' 

Members  of  the  profession  desiring  to  subscribe  for  the 
same  will  please  address  the  author,  at  loiBoylston  Street, 
Boston,  Mass. 


THE   HTJMJlN    SFINE. 


THE   GYPSUM   JACKET 

VERSUS 

COMPOUND  ADJUSTABLE  SUPPORT. 

E.  P.    BANNING,  M.   D., 

lOI    BOYLSTOK     StRBBT,    BOSTON,    MaSS« 

So  great  has  become  the  prevalence  of  spinal  irri- 
tation, caries,  and  curvature,  as  to  make  the  question 
of  the  best  means  of  their  mitigation  an  absorbing 
topic. 

Of  the  physical  means  employed  there  is  a  great 
variety  of  constructions,  with  as  great  a  variety  in 
degrees  of  merit ;  and,  as  fair  representations,  I  select 
two  (see  Figs,  i  and  3,  pages  4  and  8)  :  Fig.  i  being 
the  Gypsum  or  Plaster  Jacket,  which  has  suddenly 
sprung  into  great  popularity  under  the  aegis  of  Lewis 
Sayre,  M.  D.,  and  Fig.  3  is  the  Spinal  Prop.  Fig. 
I  certainly  has  the  merit  of  simplicity,  both  of  con- 
struction and  action,  and  Fig.  3  is  more  complex 
both  in  construction  and  action. 

Now,  as  both  plans  embody  merit,  I  propose  to  im- 
partially analyze  the  modus  operaiidi  of  these  respec- 
tive plans,  in  the  light  of  physiological  law  and  of 
natural  philosophy,  with  a  view  to  settling  the  ques- 
tion as  to  which   of  them  affords  the  greatest  advan- 


tages,  both  as  relates  to  the  temporary  and  immediate, 
and  the  tcltimate  and  per7na7ient  interest  of  the  sub- 
ject. 

We  will  suppose  the  subject  to  be  something  like 
Fig.  2  ;  the  bodies  of  some  of  the  vertebrae  are  soft- 
ened, or  tending  to  softening,  to  say  the  least ;  their 
intervening  cartilages  are  seriously  compressed,  wid- 
ened and  thinned  ;  the  face  of  the  spine  is  short- 
ened, and  its  dorsum  correspondingly  extended ;  the 
spinous  ligaments  and  dorsal  muscles,  of  consequence, 
are  put  upon  a  corresponding  strain,  and  the  superin- 
cumbent weight  of  the  superior  trunk  by  an  acquired 
leverasfe  is  coerced  to  increase  these  abnormal  condi- 
tions,  and,  all  of  these  conjointly,  must  tend  to  pro- 
gressive irritation,  inflammation,  softening  and  ab- 
sorption of  cartilage  and  bone,  and  also  to  a  painful 
strain  on  the  spinous  ligaments,  and  an  attenuation 
and  exhaustion  of  the  spinal  muscles.  It  must  also 
tend  to  compress  the  primivie,  and  depress  the  dia- 
phragm ;  impede  free  respiration,  and  to  depress  all 
the  pelvic  organs;  also,  to  impede  the  force  of  the 
sanguinous  and  nervous  circulations  in  the  inferior 
extremities.  Add  to  all  this,  also,  the  fact  that  there 
is  probably  a  constitutional  cachexy  or  dissolving 
diathesis  ;  and  further,  that  the  nervous  system  greatly 
preponderates  over  the  osseous  and  muscular,  which 
is  much  against  the  patient. 

Now,  in  order  first  to  comfort,  and  secondly  to  save 
the  patient,  several  things  (apart  from  requisite  con- 
stitutional treatment)  are  imperatively  demanded  :  — 

First.  Crushing  superincumbent  weight  must  be 
removed  from  the  softening  points  of  the  spine,  com- 


pressed  cartilages,  exhausted  spinous  ligaments  and 
spinal  muscles.  ■ 

Second.  There  must  be  some  actual  lifting-  force 
brought  to  bear  upon  the  depressed  abdominal  viscera 
and  the  settling  upper  trunk,  so  as  to  assist  the  inad- 
equate abdominal  and  spinal  muscles  in  lengthening 
the  shortened  face,  and  shortening  the  elongated  dor- 
sum of  the  spine. 

Third.  There  must  be  no  depressing  influence 
left  upon  the  abdominal  and  pelvic  viscera,  or  upon 
the  circulating  communications  of  the  extremities  ; 
and  no  compression  of  the  first  digestive  organs,  nor 
any  restriction  on  the  freest  movements  of  the  ribs, 
lungs,  or  heart. 

Foiu'th.  And  whatever  we  may  do,  nothing  must 
compromise  or  jeopardize  the  largest  strength  and 
activity  of  the  spinal,  abdominal,  and  pectoral  mus- 
cles. 

Each  of  these  points  are  of  cardinal  physiological 
importance,  more  especially  as  relates  to  the  perma- 
nent re-establishment  of  the  patient ;  and  none  of 
them  may  in  any  wise  be  disregarded  for  a  little  mere 
temporary  advantage.  With  all  these  points  in  mind, 
we  will  proceed  to  give  the  patient  what  support  and 
erection  we  can  by  the  application  of  the  Gypsum 
Jacket  (see  Fig.  2,  page  4).  Here,  it  is  on  the  subject. 
We  see  it  to  be  a  skin-fitting,  stiff,  and  unyielding  ap- 
pliance, and  that  it  fits  with  such  tightness  and  uni- 
formity everywhere  that  the  patient  can  stand,  and  is 
really  straighten  Settle  down  he  cannot,  for  he  is 
literally  hugged  and  squeezed  into  some  straightness. 
Seeing  this,  the  parents  are  in  a  transport  of  delight 
and  expectation. 


Now,  were  there  no  other  considerations  than  that 
of  straightening  the  spine  to  be  looked  after,  we 
might  always  depend  on  an  almost  indefinite  amount 
of  improvement  by  this  process,  aggressively  man- 
aged. But  how  does  this  mere  circular  Jacket  ac- 
complish all  the  above-named  indications  ?  Certainly 
not  by  the  slightest  direct  vertical  support  or  elevat- 
ing action  on  the  depressed  abdominal  organs  or 
settling  upper  trunk ;  nor  by  any  actual  supporting, 
expanding,  or  spring  action  :  but,  on  the  contrary,  by 
a  mere  circular,  horizontal,  and  squeezing  action ; 
and  this,  too,  around  the  middle  of  the  trunk,  over 
those  vital  organs  which  demand  the  freest  action  in 
the  performance  of  their  indispensable  functions. 

A  figure  of  green  putty  may  by  the  same  means 
be  made  to  stand,  and  if  held  so  till  it  dries,  may  be 
held  permanently  erect ;  but  the  living  body,  which  is 
erect  mostly  from  a  well-balanced  antagonism  of  the 
truncal  muscles,  cannot  be  dried  into  erectness  and 
strength. 

A  slim  feather  pillow  cannot  stand  erect,  yet  a  firm 
bandage  around  it  may  stiffen  it  into  position  ;  but  if 
it  is  ripped  open  at  the  top  and  well  filled  with  more 
good  feathers,  it  is  strong  of  itself^  from  internal  ex- 
pansion, now  that  its  contents  are  its  bracing-out 
support.  Just  so  is  the  body,  with  a  strong  condition 
of  the  truncal  muscles,  by  which  the  viscera  are  com- 
pacted upward ;  the  latter  are  compelled  to  brace  out, 
support,  and  give  rotundity  to  the  body,  just  as  a 
plump  body  gives  support  to  a  suit  of  well-fitting 
garments,  or  as  filling  a  bag  well  with  apples  will 
give  it  rotundity  and  erectness. 


Fig  3. 


Fig.  4. 


Fig.  3.  Revolving  Spinal  Prop.  — A  A,  plates  which  revolve  on  screw  posts,  so  as  to  fit 
the  planes  of  the  curve  on  either  side,  and  secure  an  equal  flat  support.  These  plates  are  oirved 
to  the  form,  and  may  be  run  up  and  down,  on  the  screw  posts,  to  suit  the  height  of  the  curve ; 
they  are  a  positive  protection  against  bruising  or  irritating  the  prominent  parts. 

Fig.  4.  The  Revolving  Spinal  Prop.  —  Immediately  strengthening  the  whole  person,  and 
arresting  caries  and  curvature :  First,  by  upward  support,  which  converts  the  abdominal  viscera 
into  an  internal  brace.  Second,  by  its  crutch-like  action,  which  holds  the  body's  weight  from  the 
spinal  curve.  Third,  by  a  strong  drawing  back  of  the  shoulders  by  the  caps  on  the  shoulder-bow 
in  front  of  the  heads  of  the  humeri.  And  fourth ,  by  the  strong  bracing  and  pushing-forward  action 
of  the  revolving  dorsal  plates  on  the  vertical  screw  rods  upon  the  curvature.  By  a  revolving 
action  these  plates  are  self-adjustable  to  any  slope  of  the  spinal  angle  at  either  side,  with  no 
necessity  for  any  impingement  upon  the  spinous  protuberance.  As  the  case  improves,  the  vertical 
support  may  be  successively  increased  by  means  of  slides  and  screws  in  the  &ide>posts. 


But  let  us  scrutinize  the  internal  working  of  this 
mere  squeezing  or  cheese-hoop  process.  First,  the 
stomach,  liver,  and  spleen  are  being  compressed,which 
will  tend  to  derange  the  process  of  digestion  ;  the 
bowels  are  also  more  or  less  depressed,  which  will 
tend  to  induce  urinary  irritation,  constipation,  piles, 
and  uterine  obliquities  and  displacements  from  bowel 
weight,  and  this  pressure  is  also  liable  to  be  extended 
to  an  obstruction  of  the  nervous  and  sanguineous 
circulations,  inducing  numbness  and  weakness  of  the 
inferior  extremities  ;  and  the  most  palpably  of  all,  the 
action  of  all  the  pectoral  muscles  and  of  the  lungs  is 
seriously  impeded,  so  that  respiration  (what  little 
there  is)  has  mainly  to  be  performed  by  the  abdomen  ; 
whilst  in  the  case  of  a  scrofulous  and  consumptive 
tendency,  the  lungs  are  in  danger  from  congestion 
and  lack  of  necessary  motion. 

Suppose  that  by  reason  of  a  strong  and  unsuscep- 
tible constitution  these  visceral  effects  are  sometimes 
averted ;  still,  with  so  small  an  opportunit}-  for  the 
restoration  of  the  spinal,  pectoral,  and  abdominal 
muscles  by  inherent  effort,  how  is  the  patient  to 
recover  his  wonted  strength  ?  For,  in  real  truth, 
I  have  asked  the  above  questions  with  emphasis,  in 
view  of  the  fact  that  my  earlier  and  later  efforts  to 
mitigate  uterine,  spinal,  and  other  weaknesses  by  arti- 

NoTE.  —  Dr.  Nicholas  Grattan,  in  a  letter  to  the  Lancet  regarding 
the  Jacket,  says  :  "  It  should  be  sawn  and  cut  through  a  quarter  of  an 
inch  at  each  side  of  the  median  line,  and  the  middle  strip  of  an  half 
an  inch  wide  removed.  ...  I  have  almost  always  found  on  cutting  a 
Jacket  that  it  has  become  too  large,  either  through  the  Jacket  having 
stretched,  or  the  patient  having  diminished  in  size."  The  italics  are  mine. 
Comment  is  needless.  —  Banning. 


lO 


ficial  supports  were  (and  still  are)  met  by  the  very 
grave  and  reverend  objection,  or  truism,  that  if  you 
support  a  part  that  should  support  itself,  it  becomes 
weaker,  and  you  will  always  have  to  support  it  ;  and 
yet  here  the  cure  is  attempted  by  a  process  which 
literally  paralyzes  muscular  effort,  and  is  a  direct  in- 
fringement upon  the  most  vital  functions.  Notwith- 
standing this,  I  am  convinced  that  force  enough  will 
straighten  almost  any  spine  (or  a  crowbar,  even)  ;  but 
by  this  method  how  are  you  to  keep  it  straight,  and 
^w^  permanent  spinal  and  muscular  vigor  to  the  body? 
To  me,  it  appears  that  reason  should  lead  any  one  to 
these  conclusions  ;  but  they  have  been  forced  upon 
me  by  the  observance  of  facts  in  the  premises. 

These  criticisms  may  be  met  by  the  citation  of 
cases  of  complete  success  in  cur\'ature  and  caries, 
and  of  complete  restoration  to  muscular  vigor,  just 
as  in  the  case  of  fractures,  etc.  To  this  I  reply,  first, 
that  in  fractures  there  is  no  vital  function  involved, 
or  any  danger  to  the  muscles  from  their  temporary 
confinement.  Next,  that  the  question  does  not  stand 
as  to  what  can  be  done,  or  borne,  under  an  emergency, 
but  rather,  is  there  not  a  more  excellent  way,  which  is 
equally  effective,  and  at  the  same  time  avoids  the 
specified  drawbacks  ? 

We  will  now,  in  turn,  consider  the  construction  and 
working  of  the  Revolving  Spinal  Prop  (see  Figs.  3 
and  4,  page  8).     This  appliance  seems  to  consist, — 

First.  Of  a  basic  framework  (or  terrafirma),  which 
fits  so  evenly  just  inside  and  above  the  edges  of  the 
innominatta  as  to  make  it  immovable,  and  enable  it 
to  bear  any  amount  of  weight  without  gi\4ng  pain. 


1 1 


This,  also,  has  an  undulating  and  supporting  abdom- 
inal plate  attached,  which  exerts  a  strong  tipward 
action. 

Second,  This  terra-firma  is  surmounted  by  soft 
crutches,  which  are  held  under  the  axilla  by  jointed 
side  posts,  which  are  attached  to  the  frame  as  a  base. 


Fig.  5. 

Fig.  s  represents  the  body  supported  mainly  on  right  foot.  A  A ,  perpendiculsir  line, 
from  centre  of  head  to  right  heel ;  showing  the  head  to  be  still  vertical  to  the  basal 
point.  B  B,  angular  line  indicating  the  direction  of  gravity  against  the  lumbar  spine, 
and  shoving  it  to  one  side.  C,  line  showing  the  weight  of  the  head  and  left  shoulder 
to  be  in  the  interest  of  a  dorsal  curve  to  the  right. 


12 


Third.  Next  is  a  long  spinal  lever  with  revolving 
plates  on  a  hollow  square,  which  is  attached  at  top 
and  bottom  to  the  shoulder  crutches  and  base.  Thus 
we  see  it  is  a  supplement  to  the  pelvis,  spine,  and 
chest,  and  also  to  the  abdominal,  spinal,  and  scapular 
muscles. 

We  will  now  place  this  appliance  upon  the  subject 
(see  Fig.  4,  page  8). 

First.  We  seethe  pelvic  framework  sitting  quietly 
inside  and  above  the  unyielding  pelvis,  and  ready  to 
bear  any  desired  amount  of  superincumbent  weight 
complacently. 

Second.  We  see  that  by  the  lifting  and  undulat- 
ing action  of  the  abdominal  plate  at  the  lowest  hypo- 
gastrium,  the  depressed  viscera  are  all  elevated  from 
the  pelvic  organs,  and  the  arteries,  veins,  and  nerves 
of  the  extremities  ;  also,  that  the  viscera  are  compelled 
to  ascend  to  their  normal  height  to  support  the  upper 
viscera,  and  expand  the  trunk,  at  the  now  contracted 
region  of  the  epigastrium. 

Third.  We  see  that  the  jointed  side-posts,  resting 
on  the  arches  of  the  base,  are  forcing  the  soft  crutches 
to  support  and  lift  the  superior  trunk  (at  discretion) 
off  from  the  cartilages,  softening  vertebrae,  and  diges- 
tive organs,  and  thus  to  tend  to  straighten  the  set- 
tling spine. 

Fourth.  We  see  the  spinal  lever  and  its  revolving 
plates  on  the  hollow  square,  gently  and  yet  forcibly, 
bracing  forward  the  retreating  curvature  towards  its 
proper  spinal  axis,  and  compelling  the  shoulder-caps, 
which  are  its  antipode  point,  to  correspondingly  draw 
back  the  advancing  shoulders.    Thus,  by  the  simulta- 


13 

neous  and  conjoint  lifting  action  of  the  lower  part 
upon  the  abdomen,  of  the  crutches  under  the  axilla,  and 
the  bracing  forward  and  drawing  back  action  of  the 
revolving  plates  and  the  shoulder-caps,  all  the  truncal 
muscles  (and  bones  as  well)  are  supplemented  ;  that 
the  whole  trunk,  without  and  within,  is  lengthened 
and  expanded ;  that  the  face  of  the  spine  is  being 
steadily  lengthened,  and  its  dorsum  shortened,  and 
that  the  dissolving  bones  and  cartilages  are  relieved 
of  a  disorganizing  pressure;  that  the  pelvic  organs 
and  the  circulations  of  the  extremities  are  relieved 
from  any  depressing  force ;  the  viscera,  also,  are  re- 
stored i]i  situ  to  freedom,  and  the  stomach,  liver,  and 
spleen  to  the  warming  and  stimulating  support  of  the 
bowels  ;  that  the  inverted  diaphragm  is  again  con- 
cavo-convexed  ;  that  the  heart  is  properly  supported, 
and  the  freest  play  given  to  all  the  organs  of  respira- 
tion. 

Furthermore,  a  mere  superficial  glance  will  sug- 
gest that  there  is  not  one  backward,  inward,  contract- 
ing, or  depressing  action,  nor  the  compression  of  one 
vessel,  viscus,  or  muscle ;  but  that,  on  the  contrary, 
the  spine  and  abdomen  are  shoved  outward  and  for- 
ward^ just  as  in  the  action  of  the  abdomen,  spine,  and 
scapula,  when  a  man  thinks  enough  of  himself  to 
bring  those  muscles  into  requisition  in  health.  In- 
deed, it  seems  to  act  so  in  accord  and  concord  with  the 
idea  of  the  Maker  in  setting  up  and  running  the 
body,  that  it  only  rests  the  discouraged  parts,  and  so 
helps  them  as  to  encourage  and  inspire  them  to  re- 
sume their  own  work  ;  hence  it  is,  that  unlike  too 
many  artificial  supports  which  act  by  mere  force,  out- 


14 


C     B  A 


Fig.  6. 


Showing  the  dorsolumbar  curve  retreating  from  body's  centre  of  gravity  (junction 
of  hnes  K  and  B),  and  the  palpable  necessity  for  aggressive  support  at  D. 


15 

side  of  principle,  their  use  may  always  be  ultimately 
discontinued,  for  they  have  not  only  done  their  own 
work,  but  have  set  the  weakened  parts  to  work  also. 

Thus,  gentlemen,  the  two  diverse  appliances  and 
their  principles  stand  side  by  side.  Without  a  doubt, 
under  the  wonderfully  accommodating  powers  of  the 
body,  curative  or  mitigating  results  may  occasionally 
be  wrought  by  both  of  them.  But,  as  before  said, 
the  question  stands,  not  as  to  what  has  been,  or  can 
be  done,  in  instances,  in  spite  of  principles,  but  rather, 
which  is  most  in  accord  with,  and  in  imitation  of  the 
combined  forces  of  the  body,  and  accomplishes  its 
object  with  the  least  contravention  of  physiological 
law. 

Out  of  a  mass  of  practical  tests,  I  will  now  cite 
only  one  or  two  cases  in  point,  as  being  fairly  repre- 
sentative of  the  whole.  First :  of  the  working  of  the 
Gypsum  Jacket :  — 

Case   i.  —  Miss  J ,  a  sprightly  young  lady  of 

Elmira,  N.  Y.,  consulted  me  concerning  a  decided 
curvature,  accompanied  with  much  general  weakness. 
Her  desire  for  an  improved  figure  was  intense,  and 
hence  she  had  worn  the  Gypsum  Jacket  for  six  weeks, 
under  a  great  sense  of  oppression,  burden,  and  an- 
noyance. Her  respiration  suffered  much,  and  what 
little  there  was  was  mainly  abdominal,  and  her  abdo- 
men was  protruded  and  unduly  poddy  at  the  hypogas- 
trium,  from  the  influence  of  the  Jacket  on  the  ribs 
and  bowels.  The  symptoms  of  pelvic  weakness  and 
displacements  were  emphatic,  and  her  limbs  were 
weak   and    cold.       Her   mother   felt    sure    that    her 


i6 


daughter  was  rapidly  sinking  under  the  process.  I 
was  forced  to  counsel  the  removal  of  that  kind  of  ac- 
tion, and  suggest  the  application  of  support  with  no 
countervailing  physiological  influence.  I  regret  that 
the  attendant  did  not  accept  the  advice  given ;  for 
within  the  year  my  worst  fears  were  realized. 

Case  2.  —  A  child,  four  and  a  half  years  old,  and 
the  only  daughter  of  a  professional  friend,  had  a  pos- 
terior curvature  of  the  lower  dorsal  vertebrae.  She 
was  a  child  of  remarkable  intellectual  and  personal 
attractiveness,  with  a  great  preponderance  of  the  ner- 
vous over  the  osseous  and  muscular  powers.  When  the 
apparent  lesion  amounted  to  a  "mere  knuckle,"  she 
was  taken  the  rounds  of  the  celebrities  of  New  York, 
in  turn,  but  none  of  the  steel  appliances  could  be 
borne,  on  account  of  their  weight  and  stiffness,  and 
after  full  trial  they  were  abadoned. 

Meantime,  the  curvature  increased  in  prominence, 
involving  two  more  vertebrae,  and  spinal  and  general 
weakness  steadily  increased.  At  length,  the  Jacket 
was  applied  by  the  one  above  all  others  most  skilful 
in  its  use, — Dr.  Lewis  Sayre.  This  she  bore  better 
than  she  did  the  others.  So  far  as  the  power  to 
stand  and  move  about  was  concerned,  there  w^as  some 
improvement  at  first.  The  first  Jacket  was  worn  one 
week,  and  the  second  one  seven  weeks  ;  but  during 
the  last  seven  weeks  the  curvature  involved  still 
more  vertebrae,  the  back  was  far  weaker,  and  the 
child  more  irritable  than  when  the  Jacket  was  first 
applied.  The  whole  system  seemed  to  be  struggling 
under  a  burden  of  oppression,  and  large,  dark  spots 
under  the  eyes  gave  signs  of  much  prostration.    The 


17 

mother  had  no  rest  from  the  constant  attention  de- 
manded. ''Take  me,  hold  me,  and  love  me!"  was 
the  constant  cry.  Her  sleep  was  uneasy,  and  could 
only  be  taken  when  "'  stretched  out  upon  her  back, 
like  one  in  her  coffin";  she  could  not  lie  on  her  side, 
and  the  skin  and  ribs  were  sore  from  the  pressure  of 
the  Jacket.  In  short,  the  doctor  said  "the  whole  sys- 
tem seemed  to  be  sinking  under  the  unequal  struggle, 
although  no  signs  of  real  disease  were  apparent." 

At  this  juncture  I  took  charge  of  the  case,  which, 
at  the  start,  was  the  most  irritable,  jaded,  and  crot- 
chety case  I  ever  approached.  I  removed  the  Jacket 
and  applied  a  Prop,  like  Fig.  3  (see  page  8).  Al- 
though there  was  a  terrible  scene  with  the  child  dur- 
ing its  application,  the  immediate  relief  to  the  spine 
and  the  nervous  system  was  such,  that  within  the 
first  hour  she  capered  about  the  rooms  in  high  glee, 
and,  on  my  leaving,  put  up  her  happy  face  for  a  kiss, 
unsolicited,  notwithstanding  I  had  previously  failed 
to  secure  that  favor. 

It  is  now  but  a  short  time  since  the  change  in  ap- 
pliances was  made,  and  yet  her  form  is  erect,  and 
she  is  as  playful  and  cheerful  as  a  lark.  The  doctor 
says,  "She  now  cuddles  down  on  her  side  and 
sleeps  like  a  kitten  all  night,  and  awakens  bright  and 
good  natured  in  the  morning."  Of  the  child's  own 
estimate  of  the  difference  between  the  Jacket  and 
the  Prop,  the  reader  may  judge  by  the  fact  that,  for 
purposes  of  family  government,  the  simple  threat  to 
take  away  the  Prop  and  return  to  the  Jacket  imme- 
diately brings  her  to  terms.  (But  the  subjoined  let- 
ter from  the  grateful  father  clinches  the  point.     At 


i8 


the  request  of  the  mother,  his  name,  for  the  present, 
is  not  given  ;  but  z. private  reference  can  be  had  on 
application  to  me.) 

"Orange,  N.  J.,  Dec.  15,  1877, 

**  My  dear  Dr.  Helmuth  : 

*'  This  will  be  handed  you  by  Dr.  E.  P.  Banning, 
who  has  lately  been  treating  our  little  daughter,  in 
whom  you  showed  a  kind  interest,  and  I  have  the 
extreme  and  grateful  pleasure  to  say  that  his  *  Com- 
pound Vertical  and  Bracing  Spinal  Prop,'  after  the 
failure  of  the  Plaster  Jacket,  and  other  appliances 
has  suddenly  wrought  wonders.  She  has  now  been 
under  Dr.  Banning's  care  but  a  short  time,  and  yet, 
from  being  unable  to  rest  at  night,  or  to  walk  or  stand 
more  than  a  moment  (and  that  with  distress),  she  is 
now  gay  as  a  lark,  rests  soundly,  plays  freely,  and, 
what  is  more,  her  curvature  with  unequal  hips  is 
nearly  gone. 

"Very  truly,  etc." 

These  comparisons  might  be  extended  indefinitely, 
but  as  my  object  has  been  more  to  settle  the  compar- 
ative than  the  declarative  merits  of  these  two  princi- 
ples and  plans,  I  forbear  further  citations. 

OF  the  jacket  in  bilateral  curvature. 

This  malady  consists  simply  in  the  upper  and  lower 
spine  being  so  curved  in  opposite  directions  as  to 
throw  the  body  to  one  side  of  the  true  spinal  axis, 
and  to  cause  the  body  to  rest  upon  one  foot  princi- 
pally, thereby  causing  the  body's  gravity  to  literally 


19 


Fig.  7. 


Centripetal  Spinal  Lever,  accomplishing  nothing,  its  lever  powers  not  being 
brought  around  the  shoulders. 


20 


swing  across  the  spinal  centre,  causing  one  leg  to  be 
apparently  longer  than  the  other,  and  the  hips  to 
stand  somewhat  like  a  tin  pan  tipped  up  on  one  edge 
of  the  base.  Here,  manifestly,  unequalized  weight 
from  a  one-sided  base  is  the  cause  and  perpetuation 
of  this  trouble.  It  is  also  manifest  that  to  reverse 
the  force  of  the  body's  weight  to  the  opposite  side, 
at  each  point  of  curvature,  is  the  true  principle  of 
cure  indicated ;  consequently,  if  wq  shift  the  body's 
weight  from  the  right  to  the  left  foot  we  accomplish 
the  desideratum,  for  this  effects  a  complete  reversal 
of  all  the  crushing  and  curving  forces  to  the  opposite 
side  at  each  point  of  curvature,  thereby  causing 
weight  to  brace  against  each  spinal  convexity,  and 
also  to  relax  the  strong  muscles  on  one  side,  and  to 
compel  the  dormant  and  lax  muscles  of  the  opposite 
side  to  commence  to  work  so  that  by  the  joint  action 
of  a  double  reversed  gravity,  and  a  double  reversed 
muscular  action,  the  bilaterality  is  crushed,  and 
dragged  into  axio  (see  Fig.  6,  page  14). 

But  this  (like  the  producing  curve)  is  to  be  done  by 
operating  specifically  at  one  point  and  at  the  convex- 
ity of  each  curve,  if  we  would  have  any  aid  from 
nature,  philosophy,  or  physiology.  This  action  we 
found  in  the  Centripetal  Spinal  Lever,  which  yield- 
ingly, but  forcibly,  braces  each  curvature  toward  the 
true  spinal  axis,  thereby  balancing  the  body  upon  the 
opposite  foot,  and  upon  the  spinal  centre,  when  on 
the  body  (see  Figs.  7  and  8),  and  causing  the  very 
weight  which  made  the  curvature  to  restore  symme- 
try and  strength  by  crushing  out  the  same. 

But  where  is   there  the  slightest  approximation  to 


21 


Fig.  8. 


Centripetal  Spinal  Lever  in  full  activity,  elevating  and  drawang  out  the  left 
shoulder,  drawing  in  the  right  shoulder,  supporting  the  lumbar  curve  to  the  right,  and 
aggressively  restoring  the  body  to  its  axis,  and  so  crushing  out  the  curvature  by  means 
of  the  very  gravity  which  caused  it. 


22 


a  specific  lateral  action,  even  at  one  point — and 
much  less  of  tivo  —  by  the  simple  coffin  of  the  un- 
yielding Jacket  ?  It  is  not  and  cannot  be  in  it.  All 
that  can  be  done  by  it  is  to  stretch  the  crooked  form, 
and  in  that  state  so  unyieldingly  confine  and  stiffen 
it  that  it  cannot  crook.  In  this  case  the  pressing  or 
supporting  points  will  be  at  the  top  of  the  Jacket  on 
one  side  and  at  the  bottom  on  the  other,  often  press- 
ing at  those  points  with  severity ;  but  not  one  ounce 
of  action  but  the  squeezing  one  is  exerted  anywhere, 
nor  the  slightest  approach  to  equalization  of  weight 
or  muscular  antagonism.  On  the  contrary  they  are 
discouraged.  Of  the  record  on  this  point  space 
allows  but  one  or  two  cases  :  — 

Case  i. — Miss  E ,  of  Boston,  a  tall  and  slender 

young  lady,  had  steadily  settled  into  an  advanced  bi- 
lateral curvature,  with  great  inequalities  in  the  hips 
and  shoulders,  so  as  to  require  very  heavy  padding  to 
conceal  the  deformity.  After  wearing  the  Gypsum 
Jacket  for  six  weeks,  I  was  consulted.  She  com- 
plained of  great  labor  in  respiration  ;  said  she  breathed 
principally  with  her  stomach ;  felt  oppression  about 
the  heart  and  chest ;  stomach  felt  constantly  faint ; 
a  constant  weight  and  bearing  down  at  the  inferior 
abdomen,  with  cold  feet  and  constipation.  Manifestly, 
in  her  slender  frame  every  natural  evil  tendency  was 
developed.  Indeed,  it  was  too  palpable  that  all  the 
constitutional  powers  were  suffering.  I  ordered  her 
prison-house  removed,  to  her  great  comfort.  This 
case  did  not  come  under  my  care. 


23 


SSi^S^^" 


Fig.  9. 


Fig.  9  represents  the  double-acting  spring  reverser  applied,  which,  by  its  spring 
pressure  an  the  enlarged  shoulder  and  opposite  hip,  assists  the  Centripetal  Lever  in 
swaying  the  body  into  its  axis,  at  the  same  time  leaving  the  motions  of  the  body  free. 
By  its  action  the  inequalities  of  the  hips  and  shoulders  of  young  people  are  corrected, 
with  no  deforming  appearance  through  the  apparel. 


24 


ON    THE    SPIRAL    WIRE   JACKET. 

Its  weight  is  ponderous  ;  consequently,  whilst  its 
wearers  are  obliged  to  feel  the  stiffening  effects  of  a 
squeezing  pressure,  it  exerts  not  one  concordant 
physiological  action.  Go  where  we  may,  we  find 
delicate  and  weak  sufferers  packing  these  weighty 
hugging  and  heating  things. 

But  what  would  be  the  action  of  the  Plaster,  or  of 
the  Spiral  Jacket,  v/here  such  decided  vertical  spinal 
and  abdominal  support  is  required,  with  no  positive 
power,  and  nothing  but  a  horizontal  action,  compared 
with  that  of  the  Compound  Vertical,  Bracing  and 
Expanding  Supporters  ?  Let  one  out  of  hundreds  of 
cases  answer  :  — > 

Case  2. ,  of  Boston,  was  a  very  tall  and 

naturally  beautiful  girl,  but,  at  the  age  of  sixteen, 
commenced  to  break  down  and  become  helpless  un- 
der a  bilateral  curvature  of  the  usual  character,  but 
her  weak  constitution  and  slender  make  caused  it  to 
take  away  both  health  and  strength,  and  compel  her 
to  keep  her  lounge  about  constantly.  Her  respira- 
tion was  difficult,  with  much  pain  from  the  compres- 
sion of  the  retracted  ribs  on  the  heart.  No  money 
or  means  were  spared  in  her  case ;  every  device  was 
tried,  but  there  seemed  no  hope.  In  this  case  the 
Spiral  Coil  Jacket  had  been  worn,  and  under  its  uni- 
form and  firm  hugging  action  from  the  base  of  the 
sacrum  to  the  neck,  had  held  her  somewhat  up,  but 
in  a  constant  sense  of  confinement  and  restraint.  It 
gave  no  liberty  to  any  part,  because  the  weakness 


25 


Spinal  Prop  for  Spinal  Irritation  -without  Curvaturk.  —  Fig.  lo  shows 
Fig.  3,  not  only  supporting  the  abdomen,  expanding  the  -waist  and  chest,  and  support- 
ing the  -weak  spine,  but  also  relie-ving  spinal  irritation,  by  taking  the  -weight  of  the 
body  from  tender  spinal  points,  and  protecting  the  latter  in  the  case  of  jolting  and 
twisting  the  body. 


26 

required  the  uniform  pressure  everywhere.  Doubt- 
less much  of  the  muscular  weakness  had  been  induced 
by  the  utter  disuse  of  all  the  muscles.  In  this  for- 
lorn state,  the  Centripetal  Lever  was  applied  with  all 
those  centripetating  actions  before  delineated.  It 
had  been  feared  that  the  removal  of  so  much  and 
such  extensive  circular  support  would  be  very  de- 
pressing, but,  to  the  surprise  of  all,  she  declared  the 
pains  in  chest  and  heart  were  immediately  gone  and 
her  strength  greatly  increased.  In  two  or  three  days 
this  withering  beauty  attended  and  assisted  in  an 
operatic  performance.  Within  one  month,  the  double 
curvatures  was  greatly  diminished.  The  sharply  dis- 
placed shoulder-blade  was  quite  flattened,  whilst  the 
depressed  was  much  more  prominent  ;  and  she  now 
(three  or  four  months  since)  is  a  complete  and  quite 
a  symmetrical  young  lady. 

But  why  multiply  cases  ?  The  principles  are  too 
obvious  to  require  further  elucidation  or  confirmation 
from  the  mass  of  cases  now  lying  before  us. 


SPINAL    IRRITATION. 

This  is  a  phase  of  spinal  trouble  which,  though 
not  necessarily  attended  by  any  curvature,  is  second 
to  no  caries  in  point  of  the  local  and  general  suffer- 
ings which  it  involves.  It  may  not  involve  the  slight- 
est curvature,  nor  any  apparent  undue  compression 
or  inflammation  of  the  cartilages,  nor  even  congestion 
or  redness  of  the  inediila-spi7mlis ,  or  its  meninges. 
Often,  in  the  worst  of  the  cases,  dissection  has  found 


27 

none  of  the  footprints  of  this  malady  in  any  of  the 
spinal  tissues. 

The  phenomena  are,  sense  of  pain  and  tenderness 
of  the  whole  or  a  portion  of  the  vertebrae  ;  fugitive 
or  permanent  pains  in  some  or  all  of  the  viscera  ; 
pain,  pressure,  dizziness,  confusion  and  noises  in  the 
head,  with  vigilance,  anxiety,  sleeplessness,  and  in- 
ability to  either  think  or  stop  thinking.  Usually,  all 
these  symptoms  are  aggravated  by  standing,  twisting 
the  body,  or  walking. 

Various  and  many  are  the  theories  of  its  pathology. 
Some,  that  of  local  spinal  irritation ;  some,  reflex 
action  from  the  uterus  and  other  organs,  and  probably 
there  is,  at  times,  some  truth  in  each  of  these  in  turn  ; 
but  as  a  rule,  the  corresponding  local  and  inter- 
nal treatments  fail  to  cure,  and  very  often  to  amelio- 
rate even.  But  by  far  the  most  common  theory  is 
that  of  an  irritated  or  diseased  condition  of  some 
tissue  of  the  spinal  column,  which  must  be  met  by 
diverting  such  morbid  action  to  the  surface,  by  a 
counter-surface  action.  This  is  undertaken,  first,  by 
moderate  counter-irritants,  which  (as  the  failures  may 
indicate)  are  to  become  more  and  more  severe  from 
repeated  blisters  to  setons,  the  caustic  potash,  and 
the  moxa,  and  at  length  to  the  actual  white  hot  iron 
down  the  full  length  of  the  spine  on  each  side.  This 
severe  practice  is  so  heroic  as  to  be  not  much  used 
by  modest  men,  and  is  mainly  confined  to  what  are 
called  the  higher  circles  of  practice,  among  those 
who  are  up  so  high  as  to  be  made  more  popular  ac- 
cording to  the  barbarity  which  they  practise.  But  I 
have  been  young,  and  now  am  old  ;  yet  scarcely,  if 


28 

ever,  have  I  seen  any  permanent  good  fruit  growing 
from  this  practice,  further  than  from  the  hope  and 
excitement  inspired  from  the  extremeness  of  the 
measure,  or  from  the  temporary  relief  from  one  pain, 
by  attention  having  been  drawn  to  another.  In  real 
fact,  the  latter  seems  to  be  the  rationale  to  the  sup- 
posed occasional  relief  from  the  above  practice,  oft 
repeated. 

But,  however  obscure  and  unsatisfactory  the  vari- 
ous pathologies  of  irritation  of  the  spinal  tissues  are, 
and  however  unsuccessful  the  counter-irritating  treat- 
ments are,  one  thing  is  nearly  infallibly  certain  ;  if 
you  place  your  hands  under  each  axilla  and  gently 
lift  for  five  minutes,  —  or,  if  you  at  the  same  time 
support  the  abdomen  and  the  small  of  the  back, —  the 
greatest  sufferers  universally  speak  of  a  sense  of 
rest  from  uneasiness  and  pain.  Now,  whilst  this 
cannot  prove  the  existence  of  any  particular  condi- 
tion of  the  spine,  it  must  clearly  show  that  weight 
and  friction  on  the  vertebras  aggravate  the  local  and 
radiated  sufferings,  and  most  forcibly  suggests  that  a 
part  of  the  remedy,  at  least,  is  to  elevate  the  abdom- 
inal viscera  from  the  irritable  uterus  and  ovaries,  and 
at  the  same  time  a  part  of  the  weight  from  the  irrita- 
ble cartilages,  ligaments,  and  nerves,  and  also  to  pre- 
serv^e  the  privileges  of  air,  exercise,  and  the  diver- 
sions of  society. 

For  the  accomplishment  of  all  this,  we  have,  first, 
the  circular  and  mere  horizontal  supports,  of  which 
there  are  two  kindred  varieties  :  First,  the  Gypsum 
Jacket  (see  Fig.  i) ;  second,  the  Laced  Jacket,  armed 
with  spiral  springs.     The  action  of  the  first,  as  we 


29 

have  previously  seen,  acts  only  like  a  broad  hoop  to  a 
slim  green  putty  figure,  and  does  not  remove  any 
weight,  either  by  supporting  the  abdominal  organs  or 
the  weight  of  the  upper  trunk.  The  jacket  so  often 
used  by  a  spinal  celebrity  of  this  city,  and  in  New 
York,  also  exerts  this  same  circular-hoop  action,  with 
this  difference  :  first,  it  is  yielding  and  elastic  ;  second, 
it  aims  to  give  a  lifting  and  supporting  action,  verti- 
cally, by  its  rows  of  spiral  coils  :  but  these  stop  short 
of  that  end,  because  they  have  no  pivotal  point  from 
which  to  lift,  and  what  upward  support  they  exert  is 
mainly  from  resting  downward  upon  the  already  weak 
and  relaxed  abdominal  muscles ;  thus  it  is  but  little 
more  protection  from  pressure  than  the  Gypsum 
Jacket. 

The  second  class  of  supports  is  that  represented  by 
a  modification  of  Fig.  3  (see  Fig.  10,  page  25).  This 
appliance  differs  from  Fig.  4  only  in  having  no  hollow 
square,  because  there  is  no  curvature ;  its  long  lever 
here  acting  simply  as  a  bracing  support,  or  an  artificial 
spine.  The  interpretation  of  the  whole  is,  — first,  to 
elevate  and  compact  the  whole  line  of  viscera  from 
the  uterus,  and  compel  them  to  support  the  spine 
from  within,  as  the  body  does  its  garments  ;  next,  to 
prevent  the  irritable  points  from  a  constant  aggravat- 
ing weight,  and  from  jolts  ;  third,  to  push  forward 
the  dorso-lumbar  curve,  so  as  to  relieve  the  vertebral 
bodies  and  cartilages  from  pressure,  by  balancing  the 
weight  of  the  body  directly  over  and  upon  the  central 
processes  of  the  spine.  (See  explanation  of  Fig.  3, 
whilst  upon  the  body,  page  8.) 

Thus  much  for  the  theory  of  the  malady,  and  of  the 


30 

treatment ;  but,  fortunately  for  humanity,  the  historic 
record  has  been  so  benign  as  to  far  outstrip  and  beg- 
gar any  theory.  Indeed,  so  wonderful  has  been  the 
results  of  this  appliance  in  the  premises,  in  hundreds 
of  cases,  that  I  am  barely  restrained  from  citing  quite 
a  number,  but  one  or  two  must  suffice. 

Case  i  .  —  Miss  O of  Allegheny  City,  Pa.,  had 

been  for  fourteen  years  the  subject  of  spinal  irritation 
without  curvatures.  For  seven  or  eight  years  she  was 
mainly  confined  to  bed.  The  pains  in  her  whole 
spine  and  head  were  so  unbearable  as  to  preclude 
sleep  ;  even  under  heavy  doses  of  chloral  and  mor- 
phine she  said  she  "  never  slept." ,  The  flesh  entirely 
wasted  from  her  limbs,  and  the  skin  hung  around 
them  like  a  shirt.  For  four  years  she  never  stood  or 
sat  up.  The  spine  was  untouchably  tender.  This 
case  had  sturdily  encountered  the  heroic  practice  from 
simple  blisters  all  the  way  up  to  repeated  burnings 
down  each  side  of  the  spine  with  the  hot  iron,  till 
*' the  smoke  ascended  to  the  ceiling."  This  course 
was  forlornly  pursued  until  the  surgeon  voluntarily 
retired  from  the  case,  and  "left  her  to  nature"  (quite 
wisely).  In  this  condition,  while  she  was  prone  upon 
her  back,  I  applied  the  Prop  (Fig.  6)  to  raise  weight 
from  the  uterus  and  from  the  sore  and  aching  spine. 

Result  :  On  the  first  night  she  slept,  and  from  that 
day  had  to  draw  no  more  blisters.  Soon  she  relished 
food,  and  continued  to  sleep  regularly,  and  in  four 
weeks  sat  up  (and  walked  the  room)  four  hours  a  day. 
The  flesh  also  returned  to  her  limbs  gradually,  and 
she  was  the  wonder  of  that  section  of  the  country. 


31 

#  And  now,  my  duty  done,  I  earnestly  say  to  practi- 
tioners and  to  sufferers  :  Blame  me  not  if  you  still 
pursue  the  old,  cruel,  and  unsuccessful  way,  with  such 
palpable  light  before  you.  ^ 

Fraternally  yours, 

E.  P.  BANNING,  2\I.  D. 

Biographical  Sketch. 

E.  P.  Banning,  M.  D.,  was  born  in  Caniield,  Ohio, 
in  1 8 10,  and  in  1832  entered  upon  the  practice  of  his 
profession  in  the  then  obscure  hamlet,  but  now 
flourishins:  citv  of  Titusville,  Pa. 

Struck  with  the  fact  that  an  increasing  class  of 
chronic  diseases  baffled  his,  best  efforts,  he  opened 
up  the  then  unknown  field  of  mechanical  pathology, 
and  has  sir  e  devoted  his  life,  energies,  and  talents  to 
the  prosecution  of  his  researches. 

He  had  three  sons,  Welles  Tanner  Banning 
(deceased),  E.  P.  Banning,  Jr.,  and  Archibald  Tanner 
Banning.  The  two  living  sons  are  now  engaged  in 
the  practice  of  their  professions,  and  in  the  manu- 
facture of  various  appliances  invented  by  their  father, 
with  the  improvements  and  new  ones  developed  by 
themselves. 

A  careful-  research  has  proven  the  fact  that  said 
E.  P.  Banning,  Sr.,  E.  P.  Banning,  Jr.,  and  Archibald 
T.  Banning  are  the  only  persons  of  the  name  engaged 
in  the  manufacture  of  mechanical  supports.  It  is, 
therefore,  important  that  physicians  should  order 
their  appliances  as  below  directed. 

In   many  instances  where  a  complaint   has   been 


32 

made  of  disappointment  in  the  results  obtained  from 
the  use  of  the  Banning  system  of  support,  it  has  been 
discovered  that  the  appUance,  or  appliances,  have 
b6en  manufactured,  as  a  rule,  under  the  auspices  of 
parties  utterly  unacquainted  with  physiological  law, 
or  the  needs  of  the  patient,  therefore  incompetent  to 
direct  the  manufacture  of  the  appliances  needed ; 
some  of  these  impostors  calling  themselves  by  the 
name  of  Banning.  The  profession,  therefore,  will 
recognize  the  importance  and  advantage  of  corre- 
sponding with  E.  P.  Banning,  M.  D.,  Office  and 
Residence,  ioi  Boylston  Street,  Boston,  Mass., 
U.  S.  A. ;  and  ordering  appliances  from  the  Banning 
Brace  and  Supporter  Company,  57  Tremont  Street,  of 
which  company  the  Drs.  Banning  are  the  physicians. 
Dr.  Banning  will  be  happy  to  see  any  member  of 
the  profession  at  his  office,  or  to  corresp^.JU  relative 

to  cases.  

THE  PATHOLOGY  AND  THERAPEUTICS ' 

OF 

UTERINE    DISPLACEMENTS. 

(Read  in  brief  before  the  Academy  of  Medicine,  N.  Y.) 
By  E.  P.  BANNING,  M.  D. 

"  Until  I  read  you,  the  true  rationale  of  Uterine  Displacements  was 
profoundly  unknown  to  me."  —  J.  J.  Garth  Wilkinson,  M.  D.,  Cav- 
endish Square,  London^  England. 

"Your  very  philosophical  and  well-written  essay  I  am  sure  will  be 
well  received  by  the  profession."  —  S.  W.  Butler,  M  D.,  £d.  Phila. 
Med.  and  Surg.  Reporter. 

'*  Success  MUST  attend  the  careful  carrying  out  of  your  treatment. 
It  is  the  most  philosophical  and  best  I  have  ever  met  with."  —  Henry 
R.  Madden,  M.  D.,  16  Westboum  St.,  Hyde  Park,  London. 

"  I  determined  on  the  application  of  Dr.  Banning's  treatment.  In  six 
weeks  the  patient  was  well."  —  Report  of  Stephen  A.  Smith,  M.  D. 
Prof,  of  Anatomy  at  Bellevue  College^  N.  K),  to  the  Phila.  Med.  and 
Surg.  Reporter. 

J8®=-  The  above  24  pp.  octavo  pamphlet  will  be  forwarded  to  any  medical  gentle- 
man on  receipt  of  address. 


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